Breast Procedures: Breast Augmentation

If you would like to consider an alternative to saline implants, you now have the option of having the procedure performed in London, England, where silicone gel implants are available for primary breast augmentation. A consultation can be arranged in the USA or in London with Prof. Kirwan to discuss the best type of implant for your breasts.

Prof. Kirwan now offers silicone gel breast implants in the USA as part of an Institutional Review Board Study; for patients that meet the recommended criteria. These generally include reconstructive cases such as patients with asymmetric breasts or breast ptosis. Please call our US office for more information. Prof. Kirwan uses McGhan and Mentor Breast Implants in the USA and the UK. American patients who choose to have their surgery in the UK can rest assured that their implant is made by an American Company.

Breast enlargement - what is it?

Technically known as Augmentation Mammaplasty, this is one of the most popular cosmetic procedures in the US and the United Kingdom. An implant is inserted through a small incision and positioned either behind the pectoralis major muscle or beneath the actual tissue of the breast. When the implant is beneath the muscle, it may have a more natural appearance.

An implant may look unnatural in front of the muscle if you have a small amount of breast tissue and not much subcutaneous fat. Wrinkling in the implant is also more visible when the implant is placed in front of the muscle.

The Procedure

Breast enlargement takes approximately one hour. In the United Kingdom, the surgery is carried out at a private hospital. You will usually stay in the hospital for one night. In the United States, surgery is usually performed at our Accredited Surgical Center in Norwalk, Connecticut. For patients who request or require a hospital setting, cosmetic surgery is performed at the Greenwich Hospital in Greenwich Connecticut or the New York Eye and Ear Infirmary in Manhattan, New York.

The Recovery Period

Implants are either positioned in front of or behind the muscle. After surgery, you will wear a "bandeau" (for 14 days, day and night and for 2 more weeks during the day only) to position the breast implants. In most cases, no bra is recommended for 6 weeks. Under-wire bras are usually to be avoided except for social occasions. Some sutures may be removed 4 days after surgery. Most sutures do not need to be removed. The remaining sutures will absorb spontaneously and help to give you a narrow scar that is barely visible.

Although you will be out of bed on the same day as your surgery, you will be advised when you can resume your daily routine. Light exercise, such as gentle walking, is permitted at one week, more vigorous exercise at two weeks. You may return to a regular exercise schedule at three weeks. To permit proper healing, you should avoid lifting weights for three weeks. The decision regarding when you should return to work and fully resume normal activities depends on how fast you heal and how you feel. Most patients return to work within seven days. Air travel is permitted after 5 days. No heavy lifting (greater than 5 pounds) is recommended for 10 days. You may drive after 7-10 days. Automatic transmission is easier than a manual transmission or "stick shift."

How will I look?

You will discuss the eventual size of the breasts with Prof. Kirwan during the initial consultation. Your new breasts should look and feel natural. After the procedure, most women adapt quickly to their new shape and rarely give a second thought to their implants. They will not affect fertility, pregnancy or your ability to breastfeed.

Since the purpose of the procedure is to make, your breasts look attractive;
scars are kept as small as possible and usually made either under the nipple or under the crease of the breast.

Type of implant

Breast implants are made with either a smooth or a textured surface. There are some theoretical advantages to a textured implant in that it may be associated with a decreased rate of capsular contracture.

The disadvantage of a textured implant is that it remains immobile on the chest wall and has a harder feel and more unnatural look. For this reason, Prof. Kirwan prefers silicone gel implants with a smooth envelope. The following implants are available:

Anatomically Shaped Cohesive Silicone Gel

This unique shape-retaining cohesive silicone gel implant maintains its original shape. The disadvantages of the anatomical or tear-drop shape is that it keeps the same shape in the standing and the lying position whereas a normal breast is round in the lying position and tear-drop shaped in the standing position. Studies have shown that the round implant is teardrop shaped in the standing position. Anatomical implants generally have a greater forward projection than the same volume round implant.

Silicone Gel Implants

Silicone implants have been successfully used since 1962. Silicone gel has an excellent texture as a filling material because it is soft and pliable and allows for natural movement. Silicone gel feels like natural breast tissue. The possibility of silicone interfering with the standard mammography can be overcome easily by informing your radiologist about the presence of the implant; he or she can alter the technique to obtain the optimum result (Eklund Technique). Radiologists, who perform this procedure as well as other diagnostic studies for breast tissue and implants, will be recommended in the USA and the UK. There has been no evidence that silicone gel is related to connective tissue disease. In fact, silicone appears to be one of the most inert materials known.

Capsular contracture

This is less common when the implant is beneath the muscle. The implant may have a more natural appearance when positioned behind the muscle, especially in someone with a small breast and not much fat.

Safety

Breast enlargement is a relatively safe procedure. However, as with any other surgical procedure, there are certain risks and specific complications that you should discuss with your surgeon.

In the United Kingdom, all implants are numbered and have a CE mark. You will be given a record of this to keep, as it is an important means of being able to identify your chosen implant and its origin years after it has been inserted.

More Information

Institute of Medicine booklet for women on breast implants: Information for Women About the Safety of Silicone Breast Implants, published by the prestigious Institute of Medicine (IOM).

This consumer booklet is derived from the large government-funded IOM study -- Safety of Silicone Breast Implants -- released last year. The study evaluates the evidence for associations of breast implants with human health conditions, provides a comprehensive list of references, and makes recommendations for further research. The enclosed consumer publication is a step toward meeting one of the IOM study recommendations -- that is, making the information contained in the original report available to women who have or who are considering breast implants. In this publication, the Institute of Medicine seeks to provide a short, easily understood version of that information to women.

You may wish to consider ordering a copy of this booklet if you are considering breast implants. To order contact the National Academy Press at 800-624-6242 or online at www.nap.edu. The price for booklets ordered online is $4 per copy. The full 560-page IOM report -Safety of Silicone Breast Implants -- may be ordered online for $39.20.